Provider Demographics
NPI:1780975920
Name:CORNMAN, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CORNMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 CULBERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:16242-6712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 E BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:16242-1106
Practice Address - Country:US
Practice Address - Phone:814-275-4241
Practice Address - Fax:814-275-4335
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033867T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist